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Purpose: To compare referral results from two photoscreening devices that are in wide use relative to a manual screening test protocol in preschool children. Methods: Children aged 3 to 5 years who attended preschools in two counties within the State of Michigan (N = 1,085) took part in the State's vision screening program, which included the Lea Symbols and Stereo Butterfly tests, during a 3-month period. All who failed this screening or were unable to be tested, and 20% of those who passed, were then invited to undergo testing with the Plusoptix Vision Screener Model S-12C (Plusoptix, Inc) and Welch Allyn SPOT Vision Screener Model VS-100 (Hill-Rom, Inc) photoscreening devices. Screening was conducted by State-trained technicians. With the State's test results considered the gold standard for screening, sensitivity and specificity of the two photo-screening devices were calculated. McNemar's test and logistic regression were used to evaluate the findings. Results: A total of 1,085 children took part in the State's screening program. Their mean ± standard deviation age was 48.8 ± 7.2 months, with a 51:49 female-to-male ratio, and a similar percentage were Black (34.1%) or White (33.3%). The sensitivity of the SPOT and Plusoptix screening was 61.0% and 65.2%, respectively. The specificity of the SPOT and Plusoptix screening was 92.9% and 82.4%, respectively. For 84 children who were unable to be tested by the State's screening, the SPOT and Plusoptix devices completed the screening on the majority (86.9% and 73.8%, respectively). Conclusions: The photoscreening devices yielded numerous false-negative results and fewer false-positive results. Their ability to screen many children who could not be screened by manual testing indicates a useful application. [ J Pediatr Ophthalmol Strabismus . 2022;59(1):46–52.]

Significance Vision screening can identify people who have vision problems requiring a comprehensive examination. When children are screened, the most prevalent serious problem is amblyopia secondary to uncorrected ametropia. Screening also identifies strabismus, which can lead to loss of binocularity. Early diagnosis permits treatment with restoration of balanced vision and binocularity. Purpose The study evaluated the testability of the Titmus V3 Vision Screener as a method to screen vision and strabismus in pre-school children. Methods Pre-school children between 36 and 66 months of age underwent vision screening in six Michigan counties. The State of Michigan screening consists of the LEA Symbols test for visual acuity and the stereo butterfly for near-strabismus testing. The proposed Titmus V3 screening tests were the LEA Symbols slide for vision and near-strabismus test slide. Primary and secondary objectives of this study were to evaluate the percentage of pre-school children who completed the Titmus V3 screening tests for vision and near strabismus and factors associated with an inability to complete the tests, contrasting the pass/fail results between the state and Titmus V3 results. Results Two-hundred sixty-three children were tested. The percentages of children unable to score on the Titmus V3 instrument versus the state's LEA Symbols test were 16.0% and 5.3%, respectively. The percentage of children unable to score on the Titmus V3 near-strabismus test slide was 6.9 versus 3.4% on the State of Michigan stereo butterfly test. Younger age at testing was the most important factor associated with the inability to complete testing. Conclusions Because of testability limitations and higher failure rates relative to the State of Michigan testing methods, the Titmus V3 screening device is not a feasible alternative to the standard methods used by the State of Michigan for vision and near-strabismus screening among the pre-school subjects we tested.

Purpose To determine whether enhanced follow-up after failed vision screening, involving more communication with parents/guardians than occurs in a standard protocol, would result in a higher rate of post-screening examination by an eye care provider. Methods In a study conducted from January through December 2017, 162 children in first- and third-grade who failed a vision screening in their Wayne County, Michigan, schools were randomly assigned to receive an enhanced or the standard follow-up protocol. Results The average age of the children was 7.9 ± 1.1years; 84 (52%) were males. In the enhanced follow-up group, 52 of 80 (65%) had a documented eye examination within 16 weeks of their screening; the rate in those receiving standard follow-up was 48% (39/82). The intergroup difference in follow-up was 17.4% (95% CI, 2.4%-32.5%). The enhanced follow-up group's odds of obtaining a documented eye examination was twice that of the standard follow-up group (OR = 2.05; 95% CI, 1.09-3.85; P = 0.026). Conclusions In this study cohort, methods to enhance communication proved effective in increasing the likelihood that children who failed vision screenings would receive an examination by an eye care provider.